Evaluate patients for medical necessity and determine appropriate admission status (inpatient vs. observation); collaborate with interdisciplinary teams to identify safe and cost-effective alternatives when admission is not indicated.
Facilitated communication between patients and healthcare providers to enhance service delivery.
Advocated for community resources and support services to improve patient outcomes.
Maintained accurate documentation of case management activities, ensuring regulatory compliance.
Advised physicians on alternative care levels, including skilled nursing and hospice options.
Identified community resources for housing, transportation, and financial assistance affecting health status.
Evaluated physician referrals for appropriateness of requested services across various sources.
Collaborated with payers to secure authorization for necessary services as applicable.
Participated in continuing education courses on chronic illness management and ethical considerations.
Travel Nurse - Case Manager
Georgetown University
Washington
2022.10 - 2023.07
Hospitalization throughput, managing LOS, readmissions and working towards raising HCAHPS scores.
Leader in team work by promoting communication with hospital partners to meet common goals (exceptional health care).
Demonstrated continued success with problem solving and overcoming barriers to discharge.
Collaborated with case management for successful discharge planning and utilization review (Interqual and MCG).
Participated in denial review and appeals.
Washington DC
Clinical Performance Nurse
Sound Physicians at Our Lady of Lourdes Memorial Hospital
Binghamton
2018.09 - 2022.10
Utilization Review: Interqual and MCG (EMR: Cerner) in a level one trauma center.
Continual rounding with emergency room providers to determine if admission criteria is met.
Working in conjunction with social work to find alternate LOC for patients not meeting admissions criteria.
Binghamton, NY
Travel Nurse - Case Manager
Washington Hospital Center
Washington
2017.09 - 2018.08
Screening of new patient admission (appropriateness)
Utilization review
Hospital-to-hospital transferee (adherence to EMTALA law)
Washington, DC
ED Utilization / Case Manager
Boca Raton Regional Hospital
Boca Raton
2012.01 - 2017.01
Oversaw the care, admissions, discharges and HHA training.
Lead the agency during the Initial Commission Survey and Accreditation.
Boca Raton, FL
Director of Patient Care
Community Care Home Health Services
Bohemia
2010.01 - 2012.01
Bohemia, NY
Case Management / Home Health Nursing
Gerwin Jewish Health System
Commack
2006.01 - 2010.01
Commack, NY
Case Manager
Brookhaven Memorial Hospital
Brookhaven
2003.01 - 2006.01
Brookhaven, NY
Education
Bachelor of Science - Registered Nurse
Western Governors University
Salt Lake City, UT
2026-07
A.S. - Nursing
Suffolk County Community College
2006-01
Lisenced Practical Nurse -
Eastern Suffolk BOCES
Binghamton, NY, USA
2003-01
Georgetown University
Washington, DC
Skills
Patient advocacy
Care coordination
Utilization review
Effective communication
Interdisciplinary collaboration
Health education
Certification
New York State Nursing License
References
Kathie Hine, RN, Supervisor of Clinical Performance, 607-725-9484, kathiehine@gmail.com
Signa Perkins, MD, Medical Director, 315-491-6792, signa.perkins@gmail.com
Lasongia Morton, MD, Medical Director, 404-396-6033, lmorton@soundphysicians.com